Extreme migraines during pregnancy

Migraine And Pregnancy: What Moms-to-Be Need To Know

Published: July 11, 2017

Migraine & Moms-to-Be: Making The Right Treatment Choices For Your Baby

Over 25% of women experience migraine during their lifetime, and hormone fluctuations, especially changes in estrogen levels, can have a big impact on the frequency and intensity of migraine attacks. That’s especially true of the hormonal changes that accompany pregnancy. If you are pregnant or plan to become pregnant soon, what do you need to know?

Pregnancy can have a significant impact on migraine symptoms and how women should treat them. Here’s what experts have to say.

First, the good news: Between 50 and 80% of pregnant migraine patients actually experience a reduction in migraine attacks during their pregnancy, according to David Dodick, a professor of medicine at the Mayo Clinic School of Medicine in Arizona. Many doctors believe rising estrogen levels help reduce migraine frequency and intensity. Hormone replacement therapy that mimics pregnancy’s effect on the body is increasingly being used in migraine treatment plans, especially for those who experience migraines around the time of menstruation. Caution does need to be used however in women who have migraines with aura, as the increased risk of stroke may further be increased by the addition of an estrogen-containing oral contraceptive pill.

However, some women experience migraine for the first time during pregnancy and some experience an increase in migraine symptoms especially during the first trimester. The appearance or worsening of migraine in pregnant women should be taken very seriously: Studies show that migraine symptoms, when accompanied by high blood pressure, can increase the risk of developing preeclampsia or other vascular complications. Women whose migraine symptoms don’t decrease during pregnancy should be particularly vigilant. It’s important to work with your obstetrician and your headache doctor when you have migraine to establish a safe treatment plan.

Although doctors generally advise pregnant women to avoid medications when possible, two-thirds of women take medications during pregnancy, and 50% take them during the first trimester. If you are pregnant or plan to become pregnant, you may need to reevaluate your migraine treatment options. Here’s what some experts recommend:

Identify and avoid your triggers. Experiment by avoiding foods like chocolate, caffeine, and processed foods, to see if it affects your migraines.
Make sleep a priority. Follow consistent sleep and wake times. Purchase and practice using earplugs and a sleep mask, if necessary. Use good sleep hygiene.
Stay hydrated. If you’ve ever gone to the emergency room with a migraine, you’ll remember that the first thing they do is to administer intravenous saline to combat dehydration. Your body needs far more water when you’re pregnant. Keep drinking, and consider incorporating electrolyte-rich supplementary fluids like Pedialyte.
Have a treatment plan—and a backup plan. What medications work for you, and when and how do you take them? What non-pharmaceutical treatments offer you relief? It’s good to become familiar with and discuss pain plans and pain medications with both doctors before you need them.

Migraine Medication and Pregnancy

What migraine medications are safe to take during pregnancy?

The Food and Drug Administration (FDA) sorts migraine treatments into various safety categories. The FDA classifies both prescription and non-prescription drugs into various categories based on each medication’s potential to cause birth defects. Please click here to read the FDA’s safety guide when taking medications during pregnancy.

As with any treatment plan, it’s essential that you consult with a doctor before moving forward. If you are a migraine patient and are expecting a child, make an appointment with your physician to discuss the best course of action.

Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.

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Migraines & Headaches During Pregnancy: Causes and Treatment

Written by Rebecca Buffum Taylor

If you're pregnant, you're no doubt experiencing new aches and pains. If you're also one of the millions of pregnant women who experience migraines, you might be glad to know that pregnancy eases migraine headache symptoms for many women. But even if it doesn't for you, the information in this article can help you cope.

Causes of Migraine Headaches

Exactly what causes migraine headaches isn't known. But migraines appear to involve changes in nerve pathways, neurochemicals, and blood flow in the brain.

Researchers believe that overly excited brain cells stimulate a release of chemicals. These chemicals irritate blood vessels on the brain's surface. That, in turn, causes blood vessels to swell and stimulate the pain response.

Estrogen is thought to play a role in migraines. That's why pregnancy, menstruation, and menopause often change a woman's pattern of migraine headaches.

The neurotransmitter serotonin also appears to have a key role in migraines.

Tracking Triggers With a Migraine Diary

Hormone changes during pregnancy are not the only thing that can trigger migraine headaches. Most women have a combination of triggers. For instance, stress, skipped meals, and lack of sleep may all trigger a migraine. And something that triggers a migraine one day may not bother you at all the next.

Some migraines last a few hours. Others, if left untreated, could last a couple of days. Migraines are quite unpredictable. So while pregnancy may make them worse for one woman, they might completely disappear for another.

A headache diary can let you track your particular triggers. This will help your doctor decide on what treatment will work best to relieve your specific symptoms. It may also help you recognize a pattern that tells you which triggers to avoid while you're pregnant.

Each time you have a headache, write down:

Your specific symptoms: where you feel the pain, what the pain feels like, and any other symptoms such as vomiting or sensitivity to noise, smells, or bright light
The time your headache started and ended
Food and beverages you had during the 24 hours before the migraine
Any change in your environment, such as traveling to a new place, a change in weather, or trying new kinds of food
Any treatment you tried, and whether it helped or made the headache worse

Common headache triggers include:

Chocolate
Caffeine
Foods that contain the preservatives MSG (monosodium glutamate) and nitrates
Aspartame, the sweetener in NutraSweet and Equal

Tests for Migraines

Headaches can be caused by a pregnancy complication called preeclampsia. So your doctor may evaluate you for that condition before making a diagnosis of migraine. Be sure to tell your doctor about all the medications you're taking, including over-the-counter products and natural supplements. Also let your doctor know whether anyone in your family has had migraines.

The doctor often can diagnose migraine from a headache diary and your medical history. CT scans and other radiology tests to rule out other causes of your headaches aren't usually advised in pregnancy. That's because of the potential risks to the fetus.

Self-Care of Migraines

Your first line of defense against migraine headaches is a healthy lifestyle and self-care. Here are some tips to help you manage migraines during pregnancy:

Avoid your known triggers, such as specific foods, as much as possible.
Keep a predictable schedule of meals and snacks.
Drink plenty of water.
Get plenty of rest.
Consider taking a class in biofeedback or other relaxation techniques.
When pain strikes, try ice packs, massage, and resting in a quiet, darkened room.

Medications for Migraines

If you're pregnant -- or planning to get pregnant soon -- your doctor will generally advise you to stay off medications unless they're absolutely needed. Together, you'll have to weigh the potential effects of a drug on your unborn baby. In some cases, a decision will need to be made based on scant or inconclusive research into a particular drug.

Many of the anti-migraine medications to treat or prevent migraine headache and its symptoms should be avoided during pregnancy. Some have been linked to birth defects in babies. Other medications are associated with pregnancy complications. For instance, some have been associated with bleeding, miscarriage, or intrauterine growth restriction (IUGR), a condition in which the uterus and fetus don't grow normally.

Acute Migraine Treatment

Acute treatment aims to stop a migraine attack after its first signs appear.

Pain relievers, also called analgesics, may help ease the intense pain of migraines. These general pain-relieving drugs, though, aren't specific to the migraine pain pathway:

Acetaminophen is generally considered low-risk during pregnancy.
Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, may carry a risk of bleeding and miscarriage if taken in early pregnancy. There is also a possible risk of heart complications in the baby if they are taken in the third trimester. Aspirin taken near delivery may lead to excess blood loss in mothers during birth.
Most NSAIDs, including ibuprofen -- sold over the counter under the brand names Advil and Motrin -- and naproxen -- sold as Aleve, Naprosyn and other brands -- don't have enough controlled human research studies to assess all their risks in pregnancy.
Narcotic pain relievers should generally be avoided. There is a dual risk of addiction in both mothers and babies if they are used for prolonged periods of time.

Ergotamines work specifically for migraine pain. But doctors advise against taking these drugs during pregnancy. They carry a risk of birth defects, especially if taken in the first trimester. These drugs may also stimulate labor contractions and premature birth.

Triptans work specifically on the migraine pain pathway. Triptans aren't known to cause birth defects. But most research to date has focused on animals, not humans. Your doctor can help you decide is it is safe for you and your unborn baby.

Other medications may be prescribed for relief of specific symptoms of a migraine during pregnancy. For instance, antiemetics help soothe the vomiting and nausea that can accompany a migraine. But many of the drugs typically used for migraine haven't been adequately studied in pregnancy, so their safety or risk to the fetus has not been determined.

Preventive Migraine Treatment

If you have severe, recurring attacks, preventive treatment may stop future attacks or reduce their severity. Many of the drugs used for prevention were originally used for other conditions, such as high blood pressure.

See a neurologist experienced with treating pregnant women. They'll prescribe a medicine in the lowest dose needed to help you and likely recommend some kind of talk therapy. Relatively safe medications for migraines include beta-blockers, such as metoprolol (Lopressor, Toprol XL) and propranolol (Inderal LA, Inderal XL, InnoPran XL)

When you're pregnant, always talk with your doctor before taking any drug, herbal product, or natural medicine.

If you can't take medications or wish not to, there are some devices which might be worth considering. Cefaly is a portable headband-like device that gives electrical impulses on the skin at the forehead. This stimulates a nerve associated with migraine headaches. Cefaly is used once a day for 20 minutes, and when it's on you'll feel a tingling or massaging sensation.

SpringTMS is a magnet placed on the back of the head at the first sign of a headache. It gives off a split-second magnetic pulse that stimulates part of the brain. It usually has no side effects. Also, gammaCore is a hand-held portable device which is a noninvasive vagus nerve stimulator (nVS). When placed over the vagus nerve in the neck, it releases a mild electrical stimulation to the nerve's fibers to relieve pain.

If you're seeing a headache specialist, double-check with your obstetrician or certified midwife about the safety of any medications ordevices during pregnancy. While migraine pain may be excruciating, taking a risk with your baby's health could cause lifelong health problems for your child.

Migraine during pregnancy: what to do

Migraine is a benign disease, it does not affect the course of pregnancy and fetal development. However, migraine and pregnancy is a combination that requires a responsible attitude. Especially with frequent migraines (more than 2 times a week) and migraines with aura, because:

medicines approved for use, few,
and the approach to the treatment and prevention of migraine during this period is extremely individual: it depends on the frequency, severity and duration of headache, the degree of impact on life.

Our neurologist Darya Korobkova conducted a live broadcast on the clinic's Instagram account, where she told how migraine and pregnancy are connected, why attacks become more frequent or disappear, and answered subscribers' questions. The ether was saved, see “Air recording: migraine during pregnancy and GV.

We will tell about migraine during breastfeeding separately.

The statistics of clinical observations of migraine during pregnancy looks like this:

In 60-70% of pregnant women with migraine, headache attacks become less frequent, milder, or even completely disappear in the second and third trimesters. This is due to the stabilization of estrogen levels. By the beginning of the second trimester, it rises 6 times and its fluctuations stop.

In other women, migraines during pregnancy either remain unchanged or worsen. But as the duration of pregnancy increases, the proportion of such women gradually decreases:

If at the end of the first trimester the frequency and intensity of attacks persist, then it is most likely that migraine will disturb the woman throughout the entire period of pregnancy and after childbirth too.

How to manage migraine during pregnancy?

The main thing here is to learn how to control seizures and, if necessary, seek medical help.

Follow lifestyle advice:

get enough sleep;
drink enough fluids;
eat fractionally and without long breaks;
rest;
avoid stressful situations. This is one of the main provocateurs of migraine. Psychotherapy, relaxation and stress management are here to help you.

Keep a headache diary. This will help you take control of migraine triggers.

Yes, these simple recommendations are sometimes enough to make seizures less frequent! Pregnancy is a special state of a woman. If in other periods of life we do not take such recommendations so seriously, then in this situation it is worth trying to change the philosophy of life and attitude towards ourselves =)

How to relieve an attack?

Favor non-drug methods. Sometimes, in order to relieve an attack, it is enough to eliminate an unfavorable factor:

dry biscuits, ginger, or applesauce may help with nausea;
for dehydration - diluted juice or other liquid;
sleep, walking or breathing exercises can also help to cope;

If the attacks are severe, interfere with your life, then under the supervision of a specialist, you can resort to drug therapy.

PARACETAMOL is considered the safest and can be taken throughout pregnancy.

All other drugs have nuances. For example:

ibuprofen can be taken in the second trimester, and in the first trimester it is better to limit, in the third trimester the drug is contraindicated for use;
aspirin is prohibited in the 3rd trimester and is undesirable for taking in the first two, as it can cause extremely undesirable consequences;
It is strictly forbidden to use ergotamine and opioid analgesics;
triptans are not officially approved for use during pregnancy as no controlled studies have been conducted. However, clinical observations of women around the world who took them on their own showed no adverse effects on the fetus. We discussed this issue in more detail on the air.

!Other than paracetamol, we do not recommend the use of any drug without a doctor's prescription.

When to see a doctor:

migraine occurred for the first time during pregnancy;
if migraine attacks suddenly become more frequent and stronger;
if the aura became longer or appeared for the first time;
if the headache is rapidly increasing and has an unusual character;
if the pressure rises during the headache.

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Migraine during pregnancy

How to recognize an attack and deal with it properly - read on. We will tell you how dangerous migraines are and how to get rid of them safely during pregnancy.

Contents of the article

Features and manifestations of migraine during pregnancy

If a woman was worried about migraines before pregnancy, then during the bearing of a child, the attacks are more likely to stop, or become milder and rarer. Improvements come from the 2nd trimester and are due to the fact that fluctuations in estrogen levels stop. In the early stages, the likelihood of migraine is higher. In the 1st trimester, ailments often occur, including headaches. But it's not always a migraine.

Migraine symptoms in pregnant women are similar to those that occur in other people. Approximately the picture looks like this:

Harbingers. They are not characteristic for everyone and may be absent. They occur 1-3 days before an attack, manifest as irritability, depression, or, conversely, a surge of activity.
Headache. Very intense, more often covers the temporal or frontal region, has a pulsating, arching character. It can be localized in one half of the head, but sometimes it spreads to the entire head. The pain lasts from 2-3 hours to several days, it is difficult to remove.
Aura. It also doesn't happen to everyone. The phenomenon accompanies headache and lasts 10-40 minutes. Patients note flashes of light, spots, flies before the eyes, sometimes numbness of the extremities worries. With an aura, it is almost impossible to do something around the house or work.

Even after the pain passes, the expectant mother experiences depression, fatigue, irritability. Unpleasant sensations continue for about a day.

Why do pregnant women get migraines

The exact cause of the disease has not been established. However, experts single out hormonal changes in the body and an increased load on the body during pregnancy among the provoking factors.

General risk factors:

sudden change in weather - especially for weather-sensitive women;
stress and depression have a bad effect on blood vessels and the nervous system;
violation of the diet - long intervals between meals, overeating, abuse of citrus fruits, smoked products and chocolate;
overwork - physical fatigue at home and at work, sleep disturbances;
irritants - unpleasant odors, stuffiness, excessive light or noise;
fluid deficiency - dehydration due to insufficient water intake;
concomitant pathologies, for example, hypertension.

The condition of pregnant women is adversely affected by weight gain, hypothermia and overheating. This can also provoke migraine attacks, especially if they have happened before.

Are seizures dangerous for the fetus

By itself, migraine during pregnancy is not critical. If the seizures are not caused by more serious problems - hypertension, eclampsia, then a woman is highly likely to give birth to a healthy child at term. Migraine does not increase the risk of preterm birth or developmental anomalies in the fetus.

But despite the safety for the baby, migraines are debilitating for a pregnant woman. This affects general well-being - worsens sleep, nutrition, causes stress, decreased activity. Therefore, too frequent seizures can result in problems with the nervous system, fetal hypoxia. It is important to help yourself in time.

Treatment of migraine during pregnancy

Tablets should be taken only as a last resort. In the early stages, strong drugs are prohibited. First, try to cope with non-drug methods:

Drink sweet tea or cola. Caffeine in small doses is harmless and can help relieve headaches.
Take a walk in the fresh air, do simple exercises. This contributes to the outflow of blood from the vessels of the brain and the elimination of pain.
Apply a warm or cool compress to the head. It can be a towel moistened with water or a heating pad.
Take a cool shower (but not too cold). The procedure is useful as a prevention of varicose veins and migraines.
Relax and sleep in a quiet, dark room.
Do not hold back the urge to vomit - it can relieve an attack of pain.
Rub essential oils of lemon, orange, lemon balm into whiskey - just a little is enough. Too much oil can make headaches worse. If you have previously noticed such a reaction of your body to odors, you should not apply this method now.
Drink freshly squeezed juice or clean water. Replenishing fluids often helps get rid of a migraine.

If the above measures do not help, and the seizures are disturbing enough, you need to consult a doctor. The specialist will prescribe treatment, for example, prescribe pills that will help to cope with pain. The safest drug is paracetamol. It can be taken on its own. The doctor may prescribe magnesium for treatment - it has a beneficial effect on blood vessels.

In some cases, ibuprofen and aspirin are acceptable (only in the 2nd trimester). Opioid analgesics and triptans are strictly prohibited. If a migraine is growing or has appeared for the first time, an aura has joined, pressure rises, you should definitely consult a doctor in the near future.

Prophylaxis

Dealing with migraines during pregnancy is not always easy. It is better to follow some rules that will help reduce the risk of seizures:

Stick to a sleep and rest routine.
Control sweets and fatty foods.
Try to walk every day, do light exercises.
Massage or self-massage the head and collar area. Movements should be light: it is better if the specialist shows what they should be.

Even if an attack has already happened, try not to abruptly get involved in worries and affairs after it. Remember that you are responsible not only for yourself, but also for the child. Do not be shy to turn to your loved ones for help and do not be heroic. Be healthy!